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Gu W, Li Q, Ding M, Cao Y, Wang T, Zhang S, Feng J, Li H, Zheng L. Regular Exercise Rescues Heart Function Defects and Shortens the Lifespan of Drosophila Caused by dMnM Downregulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16554. [PMID: 36554435 PMCID: PMC9779684 DOI: 10.3390/ijerph192416554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Although studies have shown that myomesin 2 (MYOM2) mutations can lead to hypertrophic cardiomyopathy (HCM), a common cardiovascular disease that has a serious impact on human life, the effect of MYOM2 on cardiac function and lifespan in humans is unknown. In this study, dMnM (MYOM2 homologs) knockdown in cardiomyocytes resulted in diastolic cardiac defects (diastolic dysfunction and arrhythmias) and increased cardiac oxidative stress. Furthermore, the knockdown of dMnM in indirect flight muscle (IFM) reduced climbing ability and shortened lifespan. However, regular exercise significantly ameliorated diastolic cardiac dysfunction, arrhythmias, and oxidative stress triggered by dMnM knockdown in cardiac myocytes and also reversed the reduction in climbing ability and shortening of lifespan caused by dMnM knockdown in Drosophila IFM. In conclusion, these results suggest that Drosophila cardiomyocyte dMnM knockdown leads to cardiac functional defects, while dMnM knockdown in IFM affects climbing ability and lifespan. Furthermore, regular exercise effectively upregulates cardiomyocyte dMnM expression levels and ameliorates cardiac functional defects caused by Drosophila cardiomyocyte dMnM knockdown by increasing cardiac antioxidant capacity. Importantly, regular exercise ameliorates the shortened lifespan caused by dMnM knockdown in IFM.
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Luongo F, Miotti C, Scoccia G, Papa S, Manzi G, Cedrone N, Toto F, Malerba C, Papa G, Caputo A, Manguso G, Adamo F, Carmine DV, Badagliacca R. Future perspective in diabetic patients with pre- and post-capillary pulmonary hypertension. Heart Fail Rev 2022; 28:745-755. [PMID: 35098382 DOI: 10.1007/s10741-021-10208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
Pulmonary hypertension is a clinical syndrome that may include multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. Pulmonary hypertension secondary to left heart disease is the prevalent clinical condition and accounts for two-thirds of all cases. Type 2 diabetes mellitus, which affects about 422 million adults worldwide, has emerged as an independent risk factor for the development of pulmonary hypertension in patients with left heart failure. While a correct diagnosis of pulmonary hypertension secondary to left heart disease requires invasive hemodynamic evaluation through right heart catheterization, several scores integrating clinical and echocardiographic parameters have been proposed to discriminate pre- and post-capillary types of pulmonary hypertension. Despite new emerging evidence on the pathophysiological mechanisms behind the effects of diabetes in patients with pre- and/or post-capillary pulmonary hypertension, no specific drug has been yet approved for this group of patients. In the last few years, the attention has been focused on the role of antidiabetic drugs in patients with pulmonary hypertension secondary to left heart failure, both in animal models and in clinical trials. The aim of the present review is to highlight the links emerged in the recent years between diabetes and pre- and/or post-capillary pulmonary hypertension and new perspectives for antidiabetic drugs in this setting.
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Affiliation(s)
- Federico Luongo
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Cristiano Miotti
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Gianmarco Scoccia
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Silvia Papa
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Giovanna Manzi
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Nadia Cedrone
- Internal Medicine Department, S. Pertini Hospital, Via dei Monti Tiburtini, 385, 00157, Roma RM. Rome, Italy
| | - Federica Toto
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Claudia Malerba
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Gennaro Papa
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Annalisa Caputo
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Giulia Manguso
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesca Adamo
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Dario Vizza Carmine
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 155, 00161, Rome, Italy.
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3
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Mulkareddy V, Simon MA. Metformin in Pulmonary Hypertension in Left Heart Disease. Front Med (Lausanne) 2020; 7:425. [PMID: 32974359 PMCID: PMC7466644 DOI: 10.3389/fmed.2020.00425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023] Open
Abstract
Metformin is ubiquitously used in the management of Type II Diabetes Mellitus (DMII). Over the years, our growing knowledge of its therapeutic potential has broadened its use to the treatment of infertility in polycystic ovarian syndrome, gestational diabetes, and even obesity. Recently, it has been suggested as a novel therapy in cardiovascular disease (CVD). Given that CVD is the leading cause of death in patients with DMII, with ~ 75% dying from a cardiovascular event, the intersection of DMII and CVD provides a unique therapeutic target. In particular, pulmonary hypertension (PH) related to CVD (Group II PH) may be an optimal target for metformin therapy. The objective of this review article is to provide an overview of the pathophysiology of PH related to left heart disease (PH-LHD), outline the proposed pathophysiologic mechanism of insulin resistance in heart failure and PH-LHD, and evaluate the role metformin may have in heart failure and PH-LHD.
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Affiliation(s)
- Vinaya Mulkareddy
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Marc A Simon
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Division of Cardiology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.,Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
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4
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Lakomkin VL, Abramov AA, Lukoshkova EV, Prosvirnin AV, Kapelko VI. [Prevention of Diastolic Dysfunction Caused by Doxorubicin by Mitochondrial Antioxidant Plastomitin]. ACTA ACUST UNITED AC 2020; 60:98-102. [PMID: 33155947 DOI: 10.18087/cardio.2020.7.n1157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
Aim An attempt to prevent the development of diastolic dysfunction (DD) with the mitochondrial antioxidant plastomitin on a model of doxorubicin-induced cardiomyopathy. DD is a type of chronic heart failure. Due to the increasing number of patients with this condition and the absence of effective therapy, development of means for DD correction is a relevant objective.Material and methods Cardiomyopathy was modeled in 17 rats by two subcutaneous injections of doxorubicin 2 mg/kg/week. The other group (n=17), also administered with doxorubicin, received plastomicin 0.32 mg/kg daily subcutaneously. Left ventricular function was evaluated with echocardiography (EchoCG) and cardiac catheterization with simultaneous pressure and volume monitoring.Results According to EchoCG data the ejection fraction remained unchanged in the experimental groups. Cardiac catheterization showed disorders of both myocardial contractility and relaxability only in the doxorubicin group.Conclusion A course of plastomitin in combination with the doxorubicin treatment can maintain normal heart contractility and thereby, prevent the known doxorubicin cardiotoxicity.
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Affiliation(s)
- V L Lakomkin
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - A A Abramov
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - E V Lukoshkova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - A V Prosvirnin
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
| | - V I Kapelko
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow
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5
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Kapelko VI. [Why Myocardial Relaxation Always Slows at Cardiac Pathology?]. ACTA ACUST UNITED AC 2019; 59:44-51. [PMID: 31849310 DOI: 10.18087/cardio.2019.12.n801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
Chronic heart failure (CHF) in most cases is due to a decrease in myocardial contractility. In particular, this results in a reduction in the maximum rate of the pressure development in the left ventricle. At the same time the maximal rate of pressure fall at relaxation is also reduced. This is not surprising, since both depend on Ca ++ myoplasmic concentration. But most of cardiac pathologies have been associated with the impairement of myocardial relaxation to a greater extent than the contraction. In the review a new view has been proposed according to which this phenomenon is attributable to restructuring of titin, the sarcomeric protein that connects the ends of myosin filaments with the sarcomeric board, lines Z. A spring-like molecule of titin shrinks at sarcomeric contraction and straightens in parallel with removing of Ca ++ from myofibrils. A reduction of its stiffness, facilitating the filling of the left ventricle, can reduce restoring force of titin and thereby slow relaxation. The survey provides information about the functions of the calcium transport system and titin in the normal heart and in CHF observed both in experimental models and in patients.
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Affiliation(s)
- V I Kapelko
- National Medical Research Center for Cardiology
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6
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Blice-Baum AC, Guida MC, Hartley PS, Adams PD, Bodmer R, Cammarato A. As time flies by: Investigating cardiac aging in the short-lived Drosophila model. Biochim Biophys Acta Mol Basis Dis 2019; 1865:1831-1844. [PMID: 30496794 PMCID: PMC6527462 DOI: 10.1016/j.bbadis.2018.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023]
Abstract
Aging is associated with a decline in heart function across the tissue, cellular, and molecular levels. The risk of cardiovascular disease grows significantly over time, and as developed countries continue to see an increase in lifespan, the cost of cardiovascular healthcare for the elderly will undoubtedly rise. The molecular basis for cardiac function deterioration with age is multifaceted and not entirely clear, and there is a limit to what investigations can be performed on human subjects or mammalian models. Drosophila melanogaster has emerged as a useful model organism for studying aging in a short timeframe, benefitting from a suite of molecular and genetic tools and displaying highly conserved traits of cardiac senescence. Here, we discuss recent advances in our understanding of cardiac aging and how the fruit fly has aided in these developments.
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Affiliation(s)
| | - Maria Clara Guida
- Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Paul S Hartley
- Bournemouth University, Department of Life and Environmental Science, Talbot Campus, Fern Barrow, Poole, Dorset BH12 5BB, UK.
| | - Peter D Adams
- Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Rolf Bodmer
- Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Anthony Cammarato
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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7
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Paradela-Dobarro B, Bravo SB, Rozados-Luís A, González-Peteiro M, Varela-Román A, González-Juanatey JR, García-Seara J, Alvarez E. Inflammatory effects of in vivo glycated albumin from cardiovascular patients. Biomed Pharmacother 2019; 113:108763. [DOI: 10.1016/j.biopha.2019.108763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022] Open
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8
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Ginsenoside Re Improves Isoproterenol-Induced Myocardial Fibrosis and Heart Failure in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3714508. [PMID: 30713572 PMCID: PMC6332977 DOI: 10.1155/2019/3714508] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/04/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Abstract
Objective. Panax ginseng is used widely for treatment of cardiovascular disorders in China. Ginsenoside Re is the main chemical component of P. ginseng. We aimed to investigate the protective effect of ginsenoside Re on isoproterenol-induced myocardial fibrosis and heart failure in rats. Methods. A model of myocardial fibrosis and heart failure was established by once-daily subcutaneous injection of isoproterenol (5 mg/kg/day) to rats for 7 days. Simultaneously, rats were orally administrated ginsenoside Re (5 or 20 mg/kg) or vehicle daily for 4 weeks. Results. Isoproterenol enhanced the heart weight, myocardial fibrosis, and hydroxyproline content in rat hearts. Ginsenoside Re inhibited (at least in part) the isoproterenol-induced increase in heart weight, myocardial fibrosis, and hydroxyproline content. Compared with the isoproterenol group, treatment with ginsenoside Re ameliorated changes in left ventricular systolic pressure, left ventricular end diastolic pressure, and the positive and negative maximal values of the first derivative of left ventricular pressure. Ginsenoside Re administration also resulted in decreased expression of transforming growth factor (TGF)-β1 in serum and decreased expression of Smad3 and collagen I in heart tissue. Conclusion. Ginsenoside Re can improve isoproterenol-induced myocardial fibrosis and heart failure by regulation of the TGF-β1/Smad3 pathway.
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Abstract
PURPOSE OF REVIEW Hypertension is the most prevalent risk factor in heart failure with preserved ejection fraction (HFpEF) and plays a key role in the disease. The continued lack of effective therapies to improve outcomes in HFpEF underscores the knowledge gaps regarding the pathophysiology of HFpEF. This review builds on fundamental concepts in pressure overload-induced left ventricular modeling, and summarizes recent knowledge gained regarding the mechanisms underlying the transition from hypertensive heart disease to HFpEF. RECENT FINDINGS The pathophysiology of hypertensive HFpEF extends beyond the development of left ventricular hypertrophy and diastolic dysfunction to myocardial contractile dysfunction, beyond left atrial structural dilatation to left atrial functional decline, beyond macrovascular stiffening to microvascular dysfunction, beyond central cardiac triggers to systemic endothelial inflammation, beyond fibrosis to titin changes, and beyond collagen deposition to qualitative changes in collagen. The central paradigm involves a systemic proinflammatory state triggering a downstream cascade of cardiac microvascular endothelial activation, oxidative stress, and abnormal myocardial cyclic guanosine monophosphate signaling, leading to microvascular rarefaction, chronic ischemia, fibrosis and progression to HFpEF. SUMMARY Recent advances have provided insights into the pathophysiology of HFpEF in hypertension. Such knowledge provides novel opportunities for therapeutic strategies in the treatment of hypertensive HFpEF.
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10
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Wu PY, Huang JC, Chen SC, Chen LI. Type 2 diabetes mellitus-related changes in left ventricular structure and function in patients with chronic kidney disease. Oncotarget 2018; 9:14661-14668. [PMID: 29581872 PMCID: PMC5865698 DOI: 10.18632/oncotarget.24482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/16/2017] [Indexed: 01/20/2023] Open
Abstract
Type 2 Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) worldwide, and is associated with an increased risk of left ventricular (LV) hypertrophy, LV systolic and diastolic dysfunctions. The aim of this study was to investigate abnormal echocardiographic findings in patients with CKD with and without DM, and identify the factors associated with these abnormalities. We enrolled 356 pre-dialysis patients with CKD (stages 3-5), including 208 with DM and 148 without DM. The structure and systolic and diastolic functions of the left ventricle were assessed using echocardiography, and the clinical and echocardiographic parameters were analyzed. The patients with DM had higher rates of observed/predicted left ventricular mass > 128% (69.5% vs. 56.7%, p = 0.015), midwall fractional shortening < 14% (22.6% vs. 8.8%, p = 0.001), and ratio of peak early transmitral filling wave velocity to early diastolic velocity of lateral mitral annulus > 12 (32.7% vs. 16.2%, p < 0.001) than those without DM. Multivariate analysis showed that male sex, a history of smoking, high systolic blood pressure, high body mass index, high levels of fasting glucose and total cholesterol, low levels of albumin and hemoglobin, and a low estimated glomerular filtration rate were associated with abnormal echocardiographic findings. The rates of inappropriate left ventricular mass, systolic and diastolic dysfunction were higher in our patients with CKD and DM than in those without DM.
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Affiliation(s)
- Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-I Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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11
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Chen PC, Huang JC, Chen SC, Wu PY, Lee JJ, Chiu YW, Chang JM, Chen HC, Huang YL. Association of type 2 diabetes mellitus and ratio of transmitral E wave velocity to early diastole mitral velocity with cardiovascular events in chronic kidney disease. Oncotarget 2017; 8:94407-94416. [PMID: 29212237 PMCID: PMC5706883 DOI: 10.18632/oncotarget.21768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/21/2017] [Indexed: 11/25/2022] Open
Abstract
The association between DM and left ventricular diastolic dysfunction, assessed using the ratio of peak early transmitral filling wave velocity (E) to early diastolic velocity of mitral annulus (Ea), with cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) remains uncertain. This study included 356 CKD stage 3–5 patients underwent echocardiography. All patients were classified into four groups based on the presence of DM and E/Ea ≤ or > 9. CV events included CV death, hospitalization for heart failure, unstable angina or nonfatal myocardial infarction, sustained ventricular arrhythmia, transient ischemic attack, and stroke. There were 58 CV events during the mean observation period of 25.0 months. A combination of the presence of DM and E/Ea > 9 (vs. a combination of non-DM and E/Ea ≤ 9) was associated with CV events in unadjusted model (hazard ratio [HR], 6.990; 95% confidence interval [CI], 2.753–17.744; p < 0.001), and in a multivariate adjusted model (HR, 3.037; 95% CI, 2.088–7.177; p = 0.025). In the patients without DM, the E/Ea ratio (p = 0.033) improved the prediction of CV events, compared to the E/Ea ratio (p = 0.018), left atrial diameter (p = 0.016) and left ventricular mass index (p = 0.001) in the patients with DM. The combination of DM and left ventricular diastolic dysfunction was associated with CV events in patients with CKD stage 3–5. Assessments of DM status and E/Ea ratio may facilitate identifying high-risk patient population of unfavorable CV outcomes.
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Affiliation(s)
- Po-Chih Chen
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yeou-Lih Huang
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan
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12
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Roselle is cardioprotective in diet-induced obesity rat model with myocardial infarction. Life Sci 2017; 191:157-165. [PMID: 29066253 DOI: 10.1016/j.lfs.2017.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 11/24/2022]
Abstract
AIMS Obesity increase the risks of hypertension and myocardial infarction (MI) mediated by oxidative stress. This study was undertaken to investigate the actions of roselle aqueous extract (R) on cardiotoxicity in obese (OB) rats and thereon OB rats subjected to MI. MAIN METHODS Male Sprague-Dawley rats were fed with either normal diet or high-fat diet for 8weeks. Firstly, OB rats were divided into (1) OB and (2) OB+R (100mg/kg, p.o, 28days). Then, OB rats were subjected to MI (ISO, 85mg/kg, s.c, 2days) and divided into three groups: (1) OB+MI, (2) OB+MI+R and (3) OB+MI+enalapril for another 4weeks. KEY FINDINGS Roselle ameliorated OB and OB+MI's cardiac systolic dysfunction and reduced cardiac hypertrophy and fibrosis. The increased oxidative markers and decreased antioxidant enzymes in OB and OB+MI groups were all attenuated by roselle. SIGNIFICANCE These observations indicate the protective effect of roselle on cardiac dysfunction in OB and OB+MI rats, which suggest its potential to be developed as a nutraceutical product for obese and obese patients with MI in the future.
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13
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Abstract
Most elderly patients, particularly women, who have heart failure, have a preserved ejection fraction. Patients with this syndrome have severe symptoms of exercise intolerance, frequent hospitalizations, and increased mortality. Despite the importance of heart failure with preserved ejection fraction (HFpEF), the understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. Unlike the management of HFrEF, there is a paucity of large evidence-based trials demonstrating morbidity and mortality benefit for the treatment of HFpEF. An update is presented on information regarding pathophysiology, diagnosis, management, and future directions in this important and growing disorder.
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Affiliation(s)
- Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Dalane W Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA.
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14
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Blice-Baum AC, Zambon AC, Kaushik G, Viswanathan MC, Engler AJ, Bodmer R, Cammarato A. Modest overexpression of FOXO maintains cardiac proteostasis and ameliorates age-associated functional decline. Aging Cell 2017; 16:93-103. [PMID: 28090761 PMCID: PMC5242305 DOI: 10.1111/acel.12543] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/27/2022] Open
Abstract
Heart performance declines with age. Impaired protein quality control (PQC), due to reduced ubiquitin‐proteasome system (UPS) activity, autophagic function, and/or chaperone‐mediated protein refolding, contributes to cardiac deterioration. The transcription factor FOXO participates in regulating genes involved in PQC, senescence, and numerous other processes. Here, a comprehensive approach, involving molecular genetics, novel assays to probe insect cardiac physiology, and bioinformatics, was utilized to investigate the influence of heart‐restricted manipulation of dFOXO expression in the rapidly aging Drosophila melanogaster model. Modest dFOXO overexpression was cardioprotective, ameliorating nonpathological functional decline with age. This was accompanied by increased expression of genes associated predominantly with the UPS, relative to other PQC components, which was validated by a significant decrease in ubiquitinated proteins. RNAi knockdown of UPS candidates accordingly compromised myocardial physiology in young flies. Conversely, excessive dFOXO overexpression or suppression proved detrimental to heart function and/or organismal development. This study highlights D. melanogaster as a model of cardiac aging and FOXO as a tightly regulated mediator of proteostasis and heart performance over time.
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Affiliation(s)
- Anna C. Blice-Baum
- Division of Cardiology; Department of Medicine; Johns Hopkins University; Baltimore MD 21205 USA
| | - Alexander C. Zambon
- Department of Biopharmaceutical Sciences; Keck Graduate Institute; Claremont CA 91711 USA
- Sanford Burnham Prebys Medical Discovery Institute, Development, Aging and Regeneration Program; La Jolla CA 92037 USA
| | - Gaurav Kaushik
- Department of Bioengineering; University of California, San Diego; La Jolla CA 92093 USA
| | - Meera C. Viswanathan
- Division of Cardiology; Department of Medicine; Johns Hopkins University; Baltimore MD 21205 USA
| | - Adam J. Engler
- Department of Bioengineering; University of California, San Diego; La Jolla CA 92093 USA
| | - Rolf Bodmer
- Sanford Burnham Prebys Medical Discovery Institute, Development, Aging and Regeneration Program; La Jolla CA 92037 USA
| | - Anthony Cammarato
- Division of Cardiology; Department of Medicine; Johns Hopkins University; Baltimore MD 21205 USA
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15
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Abstract
Heart failure (HF) is a major cardiovascular complication of diabetes mellitus (DM). The greatest risk factor for HF is age, and data indicate that 6 to 10 % of individuals over the age of 65 years suffer from HF. Patients with DM have a 2.5-fold increased risk for developing HF than individuals without DM. The 25 to 40 % of patients with HF who have DM have worse outcome (death from cardiovascular disease or hospitalization for worsening HF) than patients without DM. Hyperglycemia is a risk factor for the development of HF with an increase in incidence of HF rising from 10 % at hemoglobin A1c (HbA1c) 8.0 to 9.0 % to 71 % at a HbA1c > 10 %. Patients with DM and HF are equally distributed between those with low ejection fractions and those with normal ejection fractions. The HF treatment regimens for patients with HF and DM (blockade of angiotensin II synthesis or action, cardioselective β-adrenergic blockade, mineralocorticoid receptor blockade, and diuretics) are the same as for HF patients without DM, though the benefit on clinical outcomes is not as great. The new angiotensin-neprilysin inhibitors appear to provide increase outcome benefits in both HF patients with or without DM. Glycemic control impacts the clinical outcomes in patients with HF and DM in a U-shaped relationship with poorer survival at low and high mean HbA1c levels. The optimal chronic glycemic control occurs at an HbA1c of 7.5 to 8.0 % for patients with DM who have symptoms of HF.
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Affiliation(s)
- Gül Bahtiyar
- Division of Endocrinology, State University of New York Health Science Center, Brooklyn, NY, USA
- Department of Medicine, Woodhull Medical Mental Health Center, Brooklyn, NY, USA
- Division of Endocrinology, New York University School of Medicine, New York, NY, USA
| | - David Gutterman
- Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Harold Lebovitz
- Division of Endocrinology, State University of New York Health Science Center, Brooklyn, NY, USA.
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16
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Linssen PB, Henry RM, Schalkwijk CG, Dekker JM, Nijpels G, Brunner-La Rocca HP, Stehouwer CDA. Serum advanced glycation endproducts are associated with left ventricular dysfunction in normal glucose metabolism but not in type 2 diabetes: The Hoorn Study. Diab Vasc Dis Res 2016; 13:278-85. [PMID: 27190078 DOI: 10.1177/1479164116640680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate whether serum advanced glycation endproducts are associated with left ventricular systolic and diastolic function in participants with normal glucose metabolism, impaired glucose metabolism and type 2 diabetes mellitus. METHODS Participants from a cross-sectional, population-based study (n = 280 with normal glucose metabolism, n = 171 with impaired glucose metabolism, n = 242 with type 2 diabetes mellitus) underwent echocardiography. Serum protein-bound advanced glycation endproducts [i.e. Nε-(carboxymethyl)lysine, pentosidine and Nε-(carboxyethyl)lysine] were measured. Linear regression analyses were used and stratified according to glucose metabolism status. RESULTS In normal glucose metabolism, higher Nε-(carboxymethyl)lysine and pentosidine levels were associated with worse diastolic function (left atrial volume index and left atrial volume × left ventricular mass index product term) and higher Nε-(carboxymethyl)lysine and Nε-(carboxyethyl)lysine levels with worse systolic function (ejection fraction). In impaired glucose metabolism, a similar pattern emerged, though less consistent. In type 2 diabetes mellitus, these associations were non-existent for diastolic function or even reversed for systolic function. CONCLUSION This suggests that serum advanced glycation endproducts are associated with impaired left ventricular function in normal glucose metabolism, but that with deteriorating glucose metabolism status, serum advanced glycation endproducts may not mirror heart failure risk.
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Affiliation(s)
- Pauline Bc Linssen
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald Ma Henry
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jacqueline M Dekker
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Giel Nijpels
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Coen DA Stehouwer
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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17
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Rodrigues PG, Leite-Moreira AF, Falcão-Pires I. Myocardial reverse remodeling: how far can we rewind? Am J Physiol Heart Circ Physiol 2016; 310:H1402-22. [PMID: 26993225 DOI: 10.1152/ajpheart.00696.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 03/04/2016] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) is a systemic disease that can be divided into HF with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). HFpEF accounts for over 50% of all HF patients and is typically associated with high prevalence of several comorbidities, including hypertension, diabetes mellitus, pulmonary hypertension, obesity, and atrial fibrillation. Myocardial remodeling occurs both in HFrEF and HFpEF and it involves changes in cardiac structure, myocardial composition, and myocyte deformation and multiple biochemical and molecular alterations that impact heart function and its reserve capacity. Understanding the features of myocardial remodeling has become a major objective for limiting or reversing its progression, the latter known as reverse remodeling (RR). Research on HFrEF RR process is broader and has delivered effective therapeutic strategies, which have been employed for some decades. However, the RR process in HFpEF is less clear partly due to the lack of information on HFpEF pathophysiology and to the long list of failed standard HF therapeutics strategies in these patient's outcomes. Nevertheless, new proteins, protein-protein interactions, and signaling pathways are being explored as potential new targets for HFpEF remodeling and RR. Here, we review recent translational and clinical research in HFpEF myocardial remodeling to provide an overview on the most important features of RR, comparing HFpEF with HFrEF conditions.
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Affiliation(s)
- Patrícia G Rodrigues
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Adelino F Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, Universidade do Porto, Porto, Portugal
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18
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Lim SL, Lam CSP. Breakthrough in heart failure with preserved ejection fraction: are we there yet? Korean J Intern Med 2016; 31:1-14. [PMID: 26767852 PMCID: PMC4712413 DOI: 10.3904/kjim.2016.31.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/13/2015] [Indexed: 01/09/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFPEF) is a global health problem of considerable socioeconomic burden. It is projected to worsen with the aging population worldwide. The lack of effective therapies underscores our incomplete understanding of this complex heterogeneous syndrome. A novel paradigm has recently emerged, in which central roles are ascribed to systemic inflammation and generalized endothelial dysfunction in the pathophysiology of HFPEF. In this review, we discuss the role of the endothelium in cardiovascular homeostasis and how deranged endothelial-related signaling pathways contribute to the development of HFPEF. We also review the novel therapies in various stages of research and development that target different components of this signaling pathway.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore
| | - Carolyn Su Ping Lam
- Department of Cardiology, National Heart Center Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School, Singapore
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19
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Noninvasive Identification of ATTRwt Cardiac Amyloid: The Re-emergence of Nuclear Cardiology. Am J Med 2015; 128:1275-80. [PMID: 26091765 PMCID: PMC4798849 DOI: 10.1016/j.amjmed.2015.05.039] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 02/06/2023]
Abstract
More than half of all subjects with chronic heart failure are older adults with preserved ejection fraction (HFpEF). Effective therapy for this condition is yet to be delineated by clinical trials, suggesting that a greater understanding of underlying biologic mechanisms is needed, especially for the purpose of clinical intervention and future clinical trials. Amyloid infiltration of the myocardium is an underappreciated contributing factor to HFpEF that is often caused by misfolded monomers or oligomers of the protein transthyretin. While previously called senile cardiac amyloidosis and traditionally requiring endomyocardial biopsy for diagnosis, advances in our pathophysiologic understanding of this condition, coupled with nuclear imaging techniques using bone isotopes that can diagnose this condition noninvasively and the development of potential therapies, have resulted in a renewed interest in this previously considered "rare" condition. This reviewer focuses on the re-emergence of nuclear cardiology using pyrophosphate agents that hold promise for early, noninvasive identification of affected individuals.
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20
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Breitkreuz M, Hamdani N. A change of heart: oxidative stress in governing muscle function? Biophys Rev 2015; 7:321-341. [PMID: 28510229 DOI: 10.1007/s12551-015-0175-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023] Open
Abstract
Redox/cysteine modification of proteins that regulate calcium cycling can affect contraction in striated muscles. Understanding the nature of these modifications would present the possibility of enhancing cardiac function through reversible cysteine modification of proteins, with potential therapeutic value in heart failure with diastolic dysfunction. Both heart failure and muscular dystrophy are characterized by abnormal redox balance and nitrosative stress. Recent evidence supports the synergistic role of oxidative stress and inflammation in the progression of heart failure with preserved ejection fraction, in concert with endothelial dysfunction and impaired nitric oxide-cyclic guanosine monophosphate-protein kinase G signalling via modification of the giant protein titin. Although antioxidant therapeutics in heart failure with diastolic dysfunction have no marked beneficial effects on the outcome of patients, it, however, remains critical to the understanding of the complex interactions of oxidative/nitrosative stress with pro-inflammatory mechanisms, metabolic dysfunction, and the redox modification of proteins characteristic of heart failure. These may highlight novel approaches to therapeutic strategies for heart failure with diastolic dysfunction. In this review, we provide an overview of oxidative stress and its effects on pathophysiological pathways. We describe the molecular mechanisms driving oxidative modification of proteins and subsequent effects on contractile function, and, finally, we discuss potential therapeutic opportunities for heart failure with diastolic dysfunction.
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Affiliation(s)
- Martin Breitkreuz
- Department of Cardiovascular Physiology, Ruhr University Bochum, MA 3/56, 44780, Bochum, Germany
| | - Nazha Hamdani
- Department of Cardiovascular Physiology, Ruhr University Bochum, MA 3/56, 44780, Bochum, Germany.
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21
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Pawlak A, Gil RJ, Nasierowska-Guttmejer AM, Kasprzak JD. Changes in desmin expression in patients with cardiac diastolic dysfunction and preserved or reduced ejection fraction. Adv Med Sci 2015; 60:148-55. [PMID: 25732530 DOI: 10.1016/j.advms.2015.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Desmin regulates function of mitochondria, T-tubular system and cytosolic Ca(2+) transients. We investigated whether desmin remodeling correlates with diastolic dysfunction and whether progressive desmin abnormalities are accompanied by increasing diastolic dysfunction stages. PATIENTS AND METHODS Eighty five patients with idiopathic dilated cardiomyopathy and suspected myocarditis without confirmed cardiac tissue inflammation in histopathology assays were included and divided into groups: with preserved EF and reduced EF. After echocardiographic analysis of diastolic dysfunction we identified 2 preserved EF subgroups (normal diastolic function (NDF) and impaired relaxation (IR)) and 3 reduced EF subgroups (NDF, IR, and pseudonormalization). Patients with preserved EF and NDF formed the control group. Tissue desmin staining revealed 4 types of desmin expression: I - normal, with regular pattern of cross-section, IIA - increased with regular pattern, IIB - increased, with irregular pattern and presence of aggregates, III - decreased/lack desmin. RESULTS Desmin I was observed only in patients with NDF n=8 (100%) in preserved EF and reduced EF, desmin IIA in NDF n=8 (33%) in preserved EF and n=5 (33%) in reduced EF and IR n=16 (66%) in preserved EF and n=10 (66%) in reduced EF. Desmin IIB and III were observed in patients with reduced EF and diastolic dysfunction: IR and pseudonormalization n=9 (39%) and n=2 (29%); n=14 (61%) and n=5 (71%), respectively. Desmin was found to be an independent predictor of diastolic function parameters β=-0.63, R(2)=0.52 for E'; β=0.54, R(2)=0.42 for E/E'. CONCLUSIONS Increasing desmin abnormalities were correlated with diastolic dysfunction progression. Desmin expression represents a novel factor contributing or paralleling the development of diastolic dysfunction.
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Affiliation(s)
- Agnieszka Pawlak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland.
| | - Robert Julian Gil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland; Mossakowski Medical Research Centre, Academy of Science, Warsaw, Poland
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22
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Zile MR, Baicu CF, Ikonomidis JS, Stroud RE, Nietert PJ, Bradshaw AD, Slater R, Palmer BM, Van Buren P, Meyer M, Redfield MM, Bull DA, Granzier HL, LeWinter MM. Myocardial stiffness in patients with heart failure and a preserved ejection fraction: contributions of collagen and titin. Circulation 2015; 131:1247-59. [PMID: 25637629 DOI: 10.1161/circulationaha.114.013215] [Citation(s) in RCA: 466] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/26/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether patients with heart failure and a preserved ejection fraction (HFpEF) have an increase in passive myocardial stiffness and the extent to which discovered changes depend on changes in extracellular matrix fibrillar collagen and cardiomyocyte titin. METHODS AND RESULTS Seventy patients undergoing coronary artery bypass grafting underwent an echocardiogram, plasma biomarker determination, and intraoperative left ventricular epicardial anterior wall biopsy. Patients were divided into 3 groups: referent control (n=17, no hypertension or diabetes mellitus), hypertension (HTN) without (-) HFpEF (n=31), and HTN with (+) HFpEF (n=22). One or more of the following studies were performed on the biopsies: passive stiffness measurements to determine total, collagen-dependent and titin-dependent stiffness (differential extraction assay), collagen assays (biochemistry or histology), or titin isoform and phosphorylation assays. In comparison with controls, patients with HTN(-)HFpEF had no change in left ventricular end-diastolic pressure, myocardial passive stiffness, collagen, or titin phosphorylation but had an increase in biomarkers of inflammation (C-reactive protein, soluble ST2, tissue inhibitor of metalloproteinase 1). In comparison with both control and HTN(-)HFpEF, patients with HTN(+)HFpEF had increased left ventricular end-diastolic pressure, left atrial volume, N-terminal propeptide of brain natriuretic peptide, total, collagen-dependent, and titin-dependent stiffness, insoluble collagen, increased titin phosphorylation on PEVK S11878(S26), reduced phosphorylation on N2B S4185(S469), and increased biomarkers of inflammation. CONCLUSIONS Hypertension in the absence of HFpEF did not alter passive myocardial stiffness. Patients with HTN(+)HFpEF had a significant increase in passive myocardial stiffness; collagen-dependent and titin-dependent stiffness were increased. These data suggest that the development of HFpEF depends on changes in both collagen and titin homeostasis.
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Affiliation(s)
- Michael R Zile
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
| | - Catalin F Baicu
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - John S Ikonomidis
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Robert E Stroud
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Paul J Nietert
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Amy D Bradshaw
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Rebecca Slater
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Bradley M Palmer
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Peter Van Buren
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Markus Meyer
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Margaret M Redfield
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - David A Bull
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Henk L Granzier
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
| | - Martin M LeWinter
- From Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.)
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23
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Senni M, Paulus WJ, Gavazzi A, Fraser AG, Díez J, Solomon SD, Smiseth OA, Guazzi M, Lam CSP, Maggioni AP, Tschöpe C, Metra M, Hummel SL, Edelmann F, Ambrosio G, Stewart Coats AJ, Filippatos GS, Gheorghiade M, Anker SD, Levy D, Pfeffer MA, Stough WG, Pieske BM. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes. Eur Heart J 2014; 35:2797-815. [PMID: 25104786 PMCID: PMC4204003 DOI: 10.1093/eurheartj/ehu204] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/01/2014] [Accepted: 04/29/2014] [Indexed: 12/21/2022] Open
Abstract
The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed.
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Affiliation(s)
- Michele Senni
- Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Walter J Paulus
- Institute for Cardiovascular Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Antonello Gavazzi
- Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Javier Díez
- Division of Cardiovascular Sciences Centre for Applied Medical Research and Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto A Smiseth
- Institute for Surgical Research, Department of Cardiology, and Center for Cardiological Innovation, University of Oslo, Oslo, Norway
| | - Marco Guazzi
- Heart Failure Unit, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | | | - Carsten Tschöpe
- Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Germany
| | - Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Section of Cardiology, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | | | | | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre Gottingen, Gottingen, Germany Applied Cachexia Research, Department of Cardiology, Charite, Campus CVK, Berlin, Germany
| | - Daniel Levy
- Framingham Heart Study, Framingham, MA, USA Division of Cardiology, Boston University School of Medicine, Boston, MA, USA Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wendy Gattis Stough
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, North Carolina, USA
| | - Burkert M Pieske
- Department of Cardiology, Medical University Graz, Ludwig-Boltzmann-Institute for Heart Failure Research, Auenbruggerplatz 15, 8010 Graz, Austria
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24
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Matsubara J, Sugiyama S, Nozaki T, Akiyama E, Matsuzawa Y, Kurokawa H, Maeda H, Fujisue K, Sugamura K, Yamamoto E, Matsui K, Jinnouchi H, Ogawa H. Incremental prognostic significance of the elevated levels of pentraxin 3 in patients with heart failure with normal left ventricular ejection fraction. J Am Heart Assoc 2014; 3:jah3589. [PMID: 25012287 PMCID: PMC4310378 DOI: 10.1161/jaha.114.000928] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Pentraxin 3 (PTX3) is a novel inflammatory marker produced by various cell types including those of the vasculature and the heart. The relationship between inflammatory markers and prognosis of patients with heart failure with normal ejection fraction (HFNEF) remains unknown. We investigated whether plasma PTX3 levels can predict future cardiovascular events in patients with HFNEF. Methods and Results Plasma PTX3, high‐sensitivity C‐reactive protein, and B‐type natriuretic peptide levels were measured prospectively in 360 stable patients with HFNEF. The subsequent incidence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction (MI), unstable angina pectoris, nonfatal ischemic stroke, hospitalization for heart failure decompensation, and coronary revascularization, was determined. During a mean 30‐month follow‐up, 106 patients experienced cardiovascular events. These events were more frequent in patients with high plasma PTX3 levels (>3.0 ng/mL) than low levels (≤3.0 ng/mL). Multivariable Cox hazard analysis showed that PTX3 (hazard ratio: 1.16; 95% CI: 1.05 to 1.27; P<0.01) and B‐type natriuretic peptide (hazard ratio: 1.08; 95% CI: 1.03 to 1.14; P<0.001), but not high‐sensitivity C‐reactive protein levels, were significant predictors of future cardiovascular events. Multivariable Cox analysis with the forced inclusion model, including 5 previously identified prognostic factors, found that PTX3 was a significant predictor of cardiovascular events (hazard ratio: 1.16; 95% CI: 1.06 to 1.27; P<0.01). The C‐statistics for cardiovascular events substantially increased from 0.617 to 0.683 when PTX3 was added to the 5 previously identified prognostic factors. Conclusions High plasma PTX3 levels, but not other inflammatory markers, are correlated with future cardiovascular events in patients with HFNEF. PTX3 may be a useful biomarker for assessment of risk stratification in HFNEF. Clinical Trial Registration URL: http://www.umin.ac.jp; Unique identifier: UMIN000002170.
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Affiliation(s)
- Junichi Matsubara
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
- Department of Cardiovascular Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan (J.M.)
| | - Seigo Sugiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
- Department of Cardiovascular Medicine, and Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan (S.S., H.J.)
| | - Toshimitsu Nozaki
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Eiichi Akiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan (Y.M.)
| | - Hirofumi Kurokawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Hirofumi Maeda
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Koichi Sugamura
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
| | - Kunihiko Matsui
- Department of Community Medicine, Kumamoto University Hospital, Kumamoto, Japan (K.M.)
| | - Hideaki Jinnouchi
- Department of Cardiovascular Medicine, and Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan (S.S., H.J.)
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan (H.J.)
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (J.M., S.S., T.N., E.A., H.K., H.M., K.F., K.S., E.Y., H.O.)
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25
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Mesquita ET, Jorge AJL, de Souza CV, Cassino JPP. Systems biology applied to heart failure with normal ejection fraction. Arq Bras Cardiol 2014; 102:510-7. [PMID: 24918915 PMCID: PMC4051455 DOI: 10.5935/abc.20140062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/26/2013] [Indexed: 11/30/2022] Open
Abstract
Heart failure with normal ejection fraction (HFNEF) is currently the most
prevalent clinical phenotype of heart failure. However, the treatments available
have shown no reduction in mortality so far. Advances in the
omics sciences and techniques of high data processing used
in molecular biology have enabled the development of an integrating approach to
HFNEF based on systems biology. This study aimed at presenting a systems-biology-based HFNEF model using the
bottom-up and top-down approaches. A literature search was conducted for studies published between 1991 and 2013
regarding HFNEF pathophysiology, its biomarkers and systems biology. A
conceptual model was developed using bottom-up and top-down approaches of
systems biology. The use of systems-biology approaches for HFNEF, a complex clinical syndrome, can
be useful to better understand its pathophysiology and to discover new
therapeutic targets.
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Affiliation(s)
| | - Antonio Jose Lagoeiro Jorge
- Mailing Address: Antonio Jose Lagoeiro Jorge, Rua Coronel
Bittencourt, 66, Boa Vista. Postal Code: 24900-000, Marica, RJ - Brasil. E-mail:
,
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26
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Abstract
Heart failure with preserved ejection fraction (HFPEF) is frequently associated with multiple disorders complicating both the clinical management and the understanding of the underlying mechanisms. This review focuses on the causes and pathophysiology of HFPEF and overviews how cellular and molecular changes related to various comorbidities may influence the age-dependent and gender-dependent hemodynamic alterations of diastolic ventricular function.
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Affiliation(s)
- Árpád Kovács
- Division of Clinical Physiology, Faculty of Medicine, Institute of Cardiology, University of Debrecen, Móricz Zs. krt. 22, Debrecen 4032, Hungary
| | - Zoltán Papp
- Division of Clinical Physiology, Faculty of Medicine, Institute of Cardiology, University of Debrecen, Móricz Zs. krt. 22, Debrecen 4032, Hungary.
| | - László Nagy
- Division of Clinical Physiology, Faculty of Medicine, Institute of Cardiology, University of Debrecen, Móricz Zs. krt. 22, Debrecen 4032, Hungary
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27
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Zheng H, Li Y, Xie N. Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction. Biol Res 2014; 47:7. [PMID: 25027460 PMCID: PMC4101732 DOI: 10.1186/0717-6287-47-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/18/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction is one of the main characteristics of heart failure patients with a preserved left ventricular ejection fraction. As bilirubin is regarded as an important endogenous antioxidant molecule, serum total bilirubin levels were compared between heart failure patients with a preserved left ventricular ejection fraction and normal controls in this study. We recruited 327 heart failure patients with a preserved left ventricular ejection fraction and 200 healthy controls. Patients were divided into 4 subgroups by their comprehensive echocardiographic manifestations, 1-mild, 2-moderate, 3-severe (reversible restrictive), 4-severe (fixed restrictive). Total bilirubin levels were compared using stepwise multiple regressions adjusted for selected factors. RESULTS After adjusting for gender, age, smoking, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride, serum total bilirubin levels were significantly lower in the heart failure group compared with the control group (P < 0.01). Patients in the subgroup (4-severe) showed significantly (P < 0.05) lower levels of total bilirubin when compared with the subgroup (1-mild). CONCLUSIONS TB level was negatively correlated with left ventricular diastolic dysfunction in heart failure patients with a preserved left ventricular ejection fraction, which might provide a new insight into the complicated mechanisms of heart failure with a preserved left ventricular ejection fraction.
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Abstract
Descriptions of the pathophysiology of heart failure have gone through a substantial evolution in the last 50 years. It is now recognised that heart failure can occur in the presence and also in the absence of a reduction in left ventricular function. In the former situation, this classically has been described to lead to hypotension and secondary salt and volume retention by the kidneys, further aggravating cardiac function. In the latter, this has been described to lead to pulmonary congestion because of impaired cardiac diastolic filling. These concepts have further evolved in the discrimination of 'acute vascular' versus 'acute congestive' heart failure. The current paper builds the argument from numerous smaller observational studies that irrespective of the clinical presentation of heart failure, fluid congestion is the key. If left ventricular function is preserved, fluid retention is probably due to the inability of damaged kidneys to excrete the large amounts of salt ingested with modern diet. In the extreme of end-stage renal disease requiring haemodialysis, heart failure is frequent, but can be prevented almost entirely by strict volume control. Unfortunately, the absence of systematic studies describing fluid volumes and renal haemodynamic and reabsorptive function in patients with acute heart failure precludes the final proof of our concept. This paper therefore is a strong call for mechanistic research in this area.
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Affiliation(s)
- Evert J Dorhout Mees
- Emeritus Professor of Medicine/Nephrology, Utrecht University, Oude Zutphenseweg 3, 7251HL Vorden, The Netherlands.
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29
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Abstract
Approximately half of heart failure patients have a normal ejection fraction, a condition designated as heart failure with preserved ejection fraction (HFpEF). This heart failure subtype disproportionately affects women and the elderly and is commonly associated with other cardiovascular comorbidities, such as hypertension and diabetes. HFpEF is increasing at a steady rate and is predicted to become the leading cause of heart failure within a decade. HFpEF is characterized by impaired diastolic function, thought to be due to concentric remodeling of the heart along with increased stiffness of both the extracellular matrix and myofilaments. In addition, oxidative stress and inflammation are thought to have a role in HFpEF progression, along with endothelial dysfunction and impaired nitric oxide-cyclic guanosine monophosphate-protein kinase G signaling. Surprisingly a number of clinical studies have failed to demonstrate any benefit of drugs effective in heart failure with systolic dysfunction in HFpEF patients. Thus, HFpEF is one of the largest unmet needs in cardiovascular medicine, and there is a substantial need for new therapeutic approaches and strategies that target mechanisms specific for HFpEF. This conclusion is underscored by the recently reported disappointing results of the RELAX trial, which assessed the use of phosphodiesterase-5 inhibitor sildenafil for treating HFpEF. In animal models, endothelial nitric oxide synthase activators and If current inhibitors have shown benefit in improving diastolic function, and there is a rationale for assessing matrix metalloproteinase 9 inhibitors and nitroxyl donors. LCZ696, a combination drug of angiotensin II receptor blocker and neprilysin inhibitor, and the aldosterone receptor antagonist spironolactone are currently in clinical trial for treating HFpEF. Here we present an overview of the etiology and diagnosis of HFpEF that segues into a discussion of new therapeutic approaches emerging from basic research and drugs currently in clinical trial that primarily target diastolic dysfunction or imbalanced ventricular-arterial coupling.
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30
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Viswanathan MC, Kaushik G, Engler AJ, Lehman W, Cammarato A. A Drosophila melanogaster model of diastolic dysfunction and cardiomyopathy based on impaired troponin-T function. Circ Res 2013; 114:e6-17. [PMID: 24221941 DOI: 10.1161/circresaha.114.302028] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
RATIONALE Regulation of striated muscle contraction is achieved by Ca2+ -dependent steric modulation of myosin cross-bridge cycling on actin by the thin filament troponin-tropomyosin complex. Alterations in the complex can induce contractile dysregulation and disease. For example, mutations between or near residues 112 to 136 of cardiac troponin-T, the crucial TnT1 (N-terminal domain of troponin-T)-tropomyosin-binding region, cause cardiomyopathy. The Drosophila upheld(101) Glu/Lys amino acid substitution lies C-terminally adjacent to this phylogenetically conserved sequence. OBJECTIVE Using a highly integrative approach, we sought to determine the molecular trigger of upheld(101) myofibrillar degeneration, to evaluate contractile performance in the mutant cardiomyocytes, and to examine the effects of the mutation on the entire Drosophila heart to elucidate regulatory roles for conserved TnT1 regions and provide possible mechanistic insight into cardiac dysfunction. METHODS AND RESULTS Live video imaging of Drosophila cardiac tubes revealed that the troponin-T mutation prolongs systole and restricts diastolic dimensions of the heart, because of increased numbers of actively cycling myosin cross-bridges. Elevated resting myocardial stiffness, consistent with upheld(101) diastolic dysfunction, was confirmed by an atomic force microscopy-based nanoindentation approach. Direct visualization of mutant thin filaments via electron microscopy and 3-dimensional reconstruction resolved destabilized tropomyosin positioning and aberrantly exposed myosin-binding sites under low Ca2+ conditions. CONCLUSIONS As a result of troponin-tropomyosin dysinhibition, upheld(101) hearts exhibited cardiac dysfunction and remodeling comparable to that observed during human restrictive cardiomyopathy. Thus, reversal of charged residues about the conserved tropomyosin-binding region of TnT1 may perturb critical intermolecular associations required for proper steric regulation, which likely elicits myopathy in our Drosophila model.
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Affiliation(s)
- Meera Cozhimuttam Viswanathan
- From the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (M.C.V., A.C.); Department of Bioengineering, University of California, San Diego, La Jolla, CA (G.K., A.J.E.); and Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA (W.L.)
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Sustained cardiac remodeling after a short-term very low calorie diet in type 2 diabetes mellitus patients. Int J Cardiovasc Imaging 2013; 30:121-7. [DOI: 10.1007/s10554-013-0302-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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32
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Namekata I, Hamaguchi S, Wakasugi Y, Ohhara M, Hirota Y, Tanaka H. Ellagic acid and gingerol, activators of the sarco-endoplasmic reticulum Ca2+-ATPase, ameliorate diabetes mellitus-induced diastolic dysfunction in isolated murine ventricular myocardia. Eur J Pharmacol 2013; 706:48-55. [DOI: 10.1016/j.ejphar.2013.02.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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Kaushik G, Zambon AC, Fuhrmann A, Bernstein SI, Bodmer R, Engler AJ, Cammarato A. Measuring passive myocardial stiffness in Drosophila melanogaster to investigate diastolic dysfunction. J Cell Mol Med 2012; 16:1656-62. [PMID: 22225769 PMCID: PMC3326184 DOI: 10.1111/j.1582-4934.2011.01517.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aging is marked by a decline in LV diastolic function, which encompasses abnormalities in diastolic relaxation, chamber filling and/or passive myocardial stiffness. Genetic tractability and short life span make Drosophila melanogaster an ideal organism to study the effects of aging on heart function, including senescent-associated changes in gene expression and in passive myocardial stiffness. However, use of the Drosophila heart tube to probe deterioration of diastolic performance is subject to at least two challenges: the extent of genetic homology to mammals and the ability to resolve mechanical properties of the bilayered fly heart, which consists of a ventral muscle layer that covers the contractile cardiomyocytes. Here, we argue for widespread use of Drosophila as a novel myocardial aging model by (1) describing diastolic dysfunction in flies, (2) discussing how critical pathways involved in dysfunction are conserved across species and (3) demonstrating the advantage of an atomic force microscopy-based analysis method to measure stiffness of the multilayered Drosophila heart tube versus isolated myocytes from other model systems. By using powerful Drosophila genetic tools, we aim to efficiently alter changes observed in factors that contribute to diastolic dysfunction to understand how one might improve diastolic performance at advanced ages in humans.
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Affiliation(s)
- Gaurav Kaushik
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
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Friedman KG, McElhinney DB, Colan SD, Porras D, Powell AJ, Lock JE, Brown DW. Left ventricular remodeling and improvement in diastolic function after balloon aortic valvuloplasty for congenital aortic stenosis. Circ Cardiovasc Interv 2012; 5:549-54. [PMID: 22739787 DOI: 10.1161/circinterventions.112.968958] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In congenital aortic stenosis, chronic pressure load has detrimental effects on left ventricular (LV) systolic and diastolic function. Reduction in LV pressure load with balloon aortic valvuloplasty (BAVP) may improve diastolic function. METHODS AND RESULTS Echocardiographic and catheterization data for 25 consecutive patients undergoing BAVP for congenital aortic stenosis were retrospectively analyzed. Median age at BAVP was 11.5 years (3.2-40.1). LV end-diastolic pressure was elevated (≥15 mm Hg) in 72% of patients, with a median of 17 mm Hg (range, 9-24). With BAVP, median aortic stenosis gradient was reduced from 63 mm Hg (range, 44-105) to 30 mm Hg (range, 10-43). Aortic regurgitation increased from trivial (none to mild) to mild (trivial to moderate). Pre-BAVP early diastolic mitral inflow velocity/tissue Doppler early diastolic velocity (E/E´) correlated with LV end-diastolic pressure (r=0.52, P=0.007). On follow-up echocardiography (median, 11 months after BAVP), aortic stenosis gradient was lower (P<0.001) and degree of AR was higher (P=0.01) compared with pre-BAVP echocardiograms. LV end-diastolic volume z-score increased (P=0.02), LV mass was unchanged, and LV mass:volume decreased (P=0.002). Mitral annular and septal E´ (P<0.001) were higher and E/E´ was lower after dilation (10.8 versus 14.2, P<0.001). Lower pre-BAVP E/E´ and lower pre-BAVP LV mass z-score were associated with lower post-BAVP E/E. CONCLUSION After BAVP, LV remodeling characterized by an increase in EDV and decrease in LV mass:volume occurs and echocardiographic measures of diastolic function and LV end-diastolic pressure improve in most patients. Risk factors for persistent diastolic dysfunction include higher pre-BAVP LV mass z-score and worse pre-BAVP diastolic function.
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Affiliation(s)
- Kevin G Friedman
- Department of Cardiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
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Tsai MR, Shieh DB, Lou PJ, Lin CF, Sun CK. Characterization of oral squamous cell carcinoma based on higher-harmonic generation microscopy. JOURNAL OF BIOPHOTONICS 2012; 5:415-424. [PMID: 22461232 DOI: 10.1002/jbio.201100144] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/19/2012] [Accepted: 02/23/2012] [Indexed: 05/31/2023]
Abstract
In vivo higher-harmonic generation microscopy (HGM) performed on healthy human oral mucosa not only provides images with a <500 nm lateral resolution at a 280 μm penetration depth, but also leaves no photodamages in the tissues. These advantages suggest that HGM could serve as an ideal virtual biopsy tool for in vivo, in situ, and immediate histopathological diagnosis of oral cancer. However, translation of such mechanism for clinical cancer diagnosis requires evidence based algorithm capable to differentiate cancerous tissues from normal. It is thus critical to investigate if the endogenous contrast provided by the HGM would be high enough to differentiate cancerous versus normal tissues in human oral mucosa. In this report, ex vivo HGM study was performed on the cancerous mucosa from 10 patients with oral squamous cell carcinoma. Compared with histology, HGM revealed histopathological features including the cytological abnormalities, loss of differentiation, interruption of basement membrane, and irregular epithelial stratification in all 10 specimens. In addition, distinct patterns of collagen fibers and increased distribution area of actin filaments in tumor cells were noted. These results indicate HGM holds great potential for the optical biopsy screening of oral cancer lesions.
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Affiliation(s)
- Ming-Rung Tsai
- Department of Electrical Engineering and Graduate Institute of Photonics and Optoelectronics, National Taiwan University, Taipei, Taiwan
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Zhang Y, Edgley AJ, Cox AJ, Powell AK, Wang B, Kompa AR, Stapleton DI, Zammit SC, Williams SJ, Krum H, Gilbert RE, Kelly DJ. FT011, a new anti-fibrotic drug, attenuates fibrosis and chronic heart failure in experimental diabetic cardiomyopathy. Eur J Heart Fail 2012; 14:549-62. [PMID: 22417655 DOI: 10.1093/eurjhf/hfs011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS Cardiac remodelling in diabetes includes pathological accumulation of extracellular matrix and myocyte hypertrophy that contribute to heart dysfunction. Attenuation of remodelling represents a potential therapeutic target. We tested this hypothesis using a new anti-fibrotic drug, FT011 (Fibrotech Therapeutics Pty Ltd), on diabetic Ren-2 rats, a model which replicates many of the structural and functional manifestations of diabetic cardiomyopathy in humans. METHODS AND RESULTS Homozygous Ren-2 rats were randomized to receive streptozotocin or vehicle then further randomized to FT011 (200 mg/kg/day) or vehicle treatment for 6 weeks. Prior to tissue collection, cardiac function was assessed via echocardiography and cardiac catheterization. Total collagen deposition and cardiomyocyte hypertrophy were assessed by picrosirius red and haematoxylin and eosin staining, respectively. Macrophage interstitial infiltration and type I and III collagen were quantitated by immunostaining. Without affecting blood pressure or hyperglycaemia, treatment of diabetic rats with FT011 significantly attenuated interstitial fibrosis (total collagen, 5.09 ±1.28 vs, 2.42 ±0.43%/area; type I collagen, 4.09 ±1.16 vs. 1.42 ±0.38%/area; type III collagen, 1.52 ±0.33 vs. 0.71 ±0.14 %/area; P < 0.05), cardiomyocyte hypertrophy (882 ±38 vs. 659 ±28 µm(2); P < 0.05), and interstitial macrophage influx (66 ±5.3 vs, 44 ±7.9 number/section; P < 0.05). Cardiac myopathic dilatation was normalized, as evidenced by reduced left ventricular inner diameter at diastole (0.642 ±0.016 vs. 0.577 ±0.024 cm), increased ejection fraction (75 ±1.1 vs. 83 ±1.2%) and preload recruitable stroke work relationship (44 ±6.7 vs. 77 ±6.3 slope-mmHg; P < 0.05), and reduced end-diastolic pressure-volume relationship (0.059 ±0.011 vs. 0.02 ±0.003 slope-mmHg/μL; P < 0.05). CONCLUSIONS A direct anti-fibrotic agent, FT011, attenuates cardiac remodelling and dysfunction in experimental diabetic cardiomyopathy. This represents a novel therapy for the treatment of diabetic cardiomyopathy associated with cardiac fibrosis and hypertrophy.
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Affiliation(s)
- Yuan Zhang
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia
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Diastolic tolerance to systolic pressures closely reflects systolic performance in patients with coronary heart disease. Basic Res Cardiol 2012; 107:251. [PMID: 22311733 DOI: 10.1007/s00395-012-0251-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/05/2012] [Accepted: 01/26/2012] [Indexed: 12/18/2022]
Abstract
In animal experiments, elevating systolic pressures induces diastolic dysfunction and may contribute to congestion, a finding not yet translated to humans. Coronary surgery patients (63 ± 8 years) were studied with left ventricular (LV) pressure (n = 17) or pressure-volume (n = 3) catheters, immediately before cardiopulmonary bypass. Single-beat graded pressure elevations were induced by clamping the ascending aorta. Protocol was repeated after volume loading (n = 7). Consecutive patients with a wide range of systolic function were included. Peak isovolumetric LV pressure (LVP(iso)) ranged from 113 to 261 mmHg. With preserved systolic function, LVP elevations neither delayed relaxation nor increased filling pressures. With decreasing systolic function, diastolic tolerance to afterload progressively disappeared: relaxation slowed and filling pressures increased (diastolic dysfunction). In severely depressed systolic function, filling pressures increased even with minor LVP elevations, suggesting baseline load-dependent elevation of diastolic pressures. The magnitude of filling pressure elevation induced in isovolumetric heartbeats was closely and inversely related to systolic performance, evaluated by LVP(iso) (r = -0.96), and directly related to changes in the time constant of relaxation τ (r = 0.95). The maximum tolerated systolic LVP (without diastolic dysfunction) was similarly correlated with LVP(iso) (r = 0.99). Volume loading itself accelerated relaxation, but augmented afterload-induced upward shift of filling pressures (7.9 ± 3.7 vs. 3.0 ± 1.5; P < 0.01). The normal human response to even markedly increased systolic pressures is no slowing of relaxation and preservation of normal filling pressures. When cardiac function deteriorates, the LV becomes less tolerant, responding with slowed relaxation and increased filling pressures. This increase is exacerbated by volume loading.
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Krum H, Elsik M, Schneider HG, Ptaszynska A, Black M, Carson PE, Komajda M, Massie BM, McKelvie RS, McMurray JJ, Zile MR, Anand IS. Relation of peripheral collagen markers to death and hospitalization in patients with heart failure and preserved ejection fraction: results of the I-PRESERVE collagen substudy. Circ Heart Fail 2011; 4:561-8. [PMID: 21750125 DOI: 10.1161/circheartfailure.110.960716] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFPEF) is a common and increasing public health problem. Myocardial fibrosis is a key pathological feature of HFPEF. Peripheral collagen markers may reflect this excess fibrosis; however, the relation of these markers to prognosis in patients with HFPEF has not as yet been determined. METHODS AND RESULTS This substudy of the Irbesartan in Heart Failure With Preserved Systolic Function (I-PRESERVE) trial measured plasma levels of procollagen type I amino-terminal peptide, procollagen type III amino-terminal peptide, and osteopontin in 334 patients with HFPEF. Measurements were performed at baseline and 6 months after randomization to placebo or irbesartan 300 mg/day. The relation of baseline collagen markers to the I-PRESERVE primary end point (all-cause death and hospitalization for prespecified cardiovascular causes) was evaluated by single and multivariable analysis. Similar evaluations were performed for all-cause death alone as well as heart failure events (death or hospitalization because of heart failure). Increased plasma levels of collagen markers at baseline were associated with increased frequency of the study primary end point for all collagen markers. For each 10-μg/L increase in procollagen type I amino-terminal peptide, the hazard ratio (HR) for the primary end point was 1.09 (95% CI, 1.052 to 1.13; P<0.0001); for each 10-μg/L increase in procollagen type III amino-terminal peptide procollagen type I amino-terminal peptide, the HR was 2.47 (95% CI, 0.97 to 6.33; P=0.059); and for each 10-nmol/L increase in osteopontin, the HR was 1.084 (95% CI, 1.026 to 1.15; P=0.004). No variable remained significant as an independent predictor when introduced into a multivariable model. Both treatment groups tended to reduce collagen markers, with the reduction significantly greater for placebo versus irbesartan for procollagen type III amino-terminal peptide only (P=0.0185). CONCLUSIONS Increased peripheral collagen turnover markers were not independently associated with increased mortality and cardiovascular hospitalization in an HFPEF population on multivariable analysis but were associated on single-variable analysis. These findings provide some support to the hypothesis that pathological fibrosis in the heart, and possibly the peripheral vasculature, may be contributory to adverse clinical outcomes in patients with HFPEF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00095238.
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Affiliation(s)
- Henry Krum
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics, Monash University/Alfred Hospital, Melbourne, Victoria, Australia.
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Bhuiyan T, Maurer MS. Heart Failure with Preserved Ejection Fraction: Persistent Diagnosis, Therapeutic Enigma. CURRENT CARDIOVASCULAR RISK REPORTS 2011; 5:440-449. [PMID: 22081782 DOI: 10.1007/s12170-011-0184-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Heart failure with preserved ejection fraction (HFPEF) is increasing in prevalence with the aging of the population, and morbidity and mortality rates are comparable to that of heart failure with reduced ejection fraction (HFREF). The diagnosis can be difficult to make, especially in older adults, stemming from the presence of multiple comorbid illnesses with confounding symptoms. New diagnostic tools have resulted in guidelines proposed to define and diagnose HFPEF. Recent literature focusing on the pathophysiology underlying this disease suggests multiple mechanisms are involved in the generation of the phenotype, such as abnormal relaxation and ventricular-vascular coupling, chronotropic incompetence, volume overload, and redistribution and /or endothelial dysfunction. Currently, no clinically proven treatments are shown to decrease morbidity and mortality in this population; however, there may be a novel multidisciplinary and multistage treatment strategy that can be studied to address this complex disease which incorporates pharmacologic and non-pharmacologic therapeutics.
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Affiliation(s)
- Taslima Bhuiyan
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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Lam CSP, Lyass A, Kraigher-Krainer E, Massaro JM, Lee DS, Ho JE, Levy D, Redfield MM, Pieske BM, Benjamin EJ, Vasan RS. Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. Circulation 2011; 124:24-30. [PMID: 21670229 DOI: 10.1161/circulationaha.110.979203] [Citation(s) in RCA: 233] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) is a clinical syndrome characterized by signs and symptoms involving multiple organ systems. Longitudinal data demonstrating that asymptomatic cardiac dysfunction precedes overt HF are scarce, and the contribution of noncardiac dysfunction to HF progression is unclear. We hypothesized that subclinical cardiac and noncardiac organ dysfunction would accelerate the manifestation of HF. METHODS AND RESULTS We studied 1038 participants of the Framingham Heart Study original cohort (mean age, 76±5 years; 39% men) with routine assessment of left ventricular systolic and diastolic function. Major noncardiac organ systems were assessed with the use of serum creatinine (renal), serum albumin (hepatic), ratio of forced expiratory volume in 1 second to forced vital capacity (FEV(1):FVC ratio; pulmonary), hemoglobin concentration (hematologic/oxygen-carrying capacity), and white blood cell count (systemic inflammation). On follow-up (mean, 11 years), there were 248 incident HF events (146 in women). After adjustment for established HF risk factors, antecedent left ventricular systolic dysfunction (hazard ratio, 2.33; 95% confidence interval, 1.43 to 3.78) and diastolic dysfunction (hazard ratio, 1.32; 95% confidence interval, 1.01 to 1.71) were associated with increased HF risk. After adjustment for cardiac dysfunction, higher serum creatinine, lower FEV1:FVC ratios, and lower hemoglobin concentrations were associated with increased HF risk (all P<0.05); serum albumin and white blood cell count were not. Subclinical dysfunction in each noncardiac organ system was associated with a 30% increased risk of HF (P=0.013). CONCLUSIONS Antecedent cardiac dysfunction and noncardiac organ dysfunction are associated with increased incidence of HF, supporting the notion that HF is a progressive syndrome and underscoring the importance of noncardiac factors in its occurrence.
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Affiliation(s)
- Carolyn S P Lam
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA 01702-5803, USA
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Edgley AJ, Krum H, Kelly DJ. Targeting fibrosis for the treatment of heart failure: a role for transforming growth factor-β. Cardiovasc Ther 2010; 30:e30-40. [PMID: 21883991 DOI: 10.1111/j.1755-5922.2010.00228.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Chronic heart failure (CHF) is a growing health problem in developed nations. The pathological accumulation of extracellular matrix is a key contributor to CHF in both diabetic and nondiabetic states, resulting in progressive stiffening of the ventricular walls and loss of contractility. Proinflammatory disease processes, including inflammatory cytokine activation, contribute to accumulation of extracellular matrix in the heart. Transforming growth factor-β is a key profibrotic cytokine mediating fibrosis. Current therapeutic strategies do not directly target the profibrotic inflammatory processes occurring in the heart and hence there is a clear unmet clinical need to develop new therapeutic agents targeting fibrosis. Accordingly, strategies that inhibit proinflammatory cytokine activation and pathological accumulation of extracellular matrix (ECM) provide a potential therapeutic target for prevention of heart failure. This review focuses on the therapeutic targeting of TGF-β in the prevention of pathological fibrosis in the heart.
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Affiliation(s)
- Amanda J Edgley
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Victoria, Australia
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What we know and do not know about sex and cardiac disease. J Biomed Biotechnol 2010; 2010:562051. [PMID: 20445744 PMCID: PMC2860154 DOI: 10.1155/2010/562051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/16/2010] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) remains the single leading cause of death in both men and women. A large proportion of the population with CVD will die with a diagnosis of congestive heart failure (CHF). It is becoming increasingly recognized that sex differences exist in the etiology, development, and outcome of CHF. For example, compared to male counterparts, women that present with CHF are typically older and have systolic cardiac function that is not impaired. Despite a growing body of literature addressing the underlying mechanisms of sex dimorphisms in cardiac disease, there remain significant inconsistencies reported in these studies. Given that the development of CHF results from the complex integration of genetic and nongenetic cues, it is not surprising that the elucidation and subsequent identification of molecular mechanisms remains unclear. In this review, key aspects of sex differences in CVD and CHF will be highlighted with an emphasis on some of the unanswered questions regarding these differences. The contention is presented that it becomes critical to reference cellular mechanisms within the context of each sex to better understand these sex dimorphisms.
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Kumar S, Seth S, Jaiswal A, Enjamoori R, Dinda AK, Ray R, Maulik SK. Chronic β-adrenergic activation-induced left ventricular systolic dysfunction is associated with systemic release of TNF-α and IL-1-β in rats. Pharmacol Rep 2009; 61:870-6. [DOI: 10.1016/s1734-1140(09)70143-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 09/25/2009] [Indexed: 12/01/2022]
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